HIV PEP(POST-EXPOSURE PROPHYLAXIS) Dr. Dino Sgarabotto Malattie Infettive e Tropicali Azienda Ospedaliera di Padova
WHAT IS HIV- PEP?• HIV is the human immunodeficiency virus. It is the virus that can lead to acquired immune deficiency syndrome, or AIDS.• PEP involves taking anti-HIV drugs as soon as possible after having been exposed• To be effective, PEP must begin within 72 hours after exposure, before the virus has the time rapidly replicate in your body• PEP consists of 2-3 anti-HIV medications taken every day for 1 month
PEP means Post-Exposure Prophylaxis• Prophylaxis means disease prevention• PEP involves taking anti-HIV drugs as soon as possible after you may have been exposed to HIV to try to reduce the chance of becoming HIV positive; occupational PEP (health-care setting) and non-occupational PEP (condom breakage, sexual assault, etc.)• The medications may have side effects that can make it difficult to finish the program. PEP is not 100% effective; it does not guarantee that someone exposed to HIV will not become infected with HIV.
Who needs PEP?• PEP is usually used for anyone who may have been exposed to HIV.• Healthcare workers have the greatest risk. They can be exposed to HIV by: – Needle sticks or cuts – Getting blood or other body fluids in their eyes or mouth – Getting blood or other body fluids on their skin when it is scraped, or affected by dermatitis• The risk of HIV transmission in these ways is low—less than 1% for each exposure
Why can’t PEP therapy be taken after72 hours from the point of exposure?• HIV grows faster and faster once it enters your body.• If you start taking PEP more than 72 hours after exposure, the meds can’t keep up, and research has shown that PEP has little or no effect in preventing HIV infection after the 72-hour mark.• Better if PEP starts within 6 hours from injury
Different kind of exposure• Exposure to a large amount of blood.• Blood came in contact with cuts or open sores on the skin.• Blood was visible on a needle that stuck someone.• Exposure to blood from someone who has a high viral load (a large amount of virus in the blood).• For serious exposures, it is recommended using a combination of three drugs for four weeks. For less serious exposure, the guidelines recommend treatment with two drugs for four weeks: AZT and 3TC
Two drug regimens• AZT and 3TC: Zidovudine 300 mg BID + Lamivudine 150 mg BID or Combivir 1 Tab BID +• FTC and TDF: Emtricitabine 200 mg OD + Tenofovir 300 mg OD or Truvada 1 Tab OD
Three drug regimens• Combivir BID or Truvada OD• Associated with: – Lopinavir 400 mg and Ritonavir 100 mg BID: Kaletra 2 tabs BID or – Atazanavir 300 mg OD + Ritonavir 100 mg OD: Reyataz 300 mg OD and Norvir 100 mg OD
Combivir/Kaletra +BD: twice a day regimen; 6 Tabs a day
Truvada/Reyataz/Norvir OD: once a day regimen; 3 Tabs a day
WHAT ARE THE SIDE EFFECTS?• The most common side effects from PEP medications are nausea and generally not feeling well.• Other possible side effects include headaches, fatigue, vomiting and diarrhea.
Prevention strategies• Health care workers should assume that the blood and other body fluids from all patients are potentially infectious. They should therefore follow infection control precautions at all times.• Routinely using barriers (such as gloves and/ or goggles) when anticipating contact with blood or body fluids,• Immediately washing hands and other skin surfaces after contact with blood or body fluids, and• Carefully handling and disposing of sharp instruments during and after use.
Disposal containers• Safety devices have been developed to help prevent needle-stick injuries. If used properly, these types of devices may reduce the risk of exposure to HIV.• Many percutaneous injuries, such as needle- sticks and cuts, are related to sharps disposal. Strategies for safer disposal, including safer design of disposal containers and placement of containers, are being developed.
Conclusions• Post-exposure prophylaxis (PEP) is the use of anti-HIV drugs as soon as possible after exposure to HIV, to prevent HIV infection. PEP can reduce the rate of infection in health care workers exposed to HIV by 79%.• The benefits of PEP for non-occupational exposure have not been proven. This use of PEP is controversial because some people fear it will encourage unsafe behaviors.
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